Objective:To investigate the feasibility of a new clinical grading scale for assessing the degree of laxity of upper eyelid skin.Methods:From May 2022 to October 2023, the patients who underwent upper eyelid skin laxity plastic surgery in the Department of Plastic Surgery and Burns-Department of Medical Cosmetology, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, were prospectively enrolled. The degree of upper eyelid skin laxity was graded independently by three plastic surgeons who did not participate in the operation according to the grading scale and using facial photographs of the patients.The clinical grading scale categorizes the degree of skin laxity into 4 grades ranging from 0 to 3 degrees, by analyzing the position of the lower edge of the upper eyelid skin relative to the upper eyelid edge and the pupil, and the higher the grade, the more serious the degree of skin relaxation. If bilateral upper eyelid skin laxity were presented, the grade of the side with more severe laxity was taken as the grade of the upper eyelid skin laxity of the patient. The Kendall coefficient (range -1-1) of the three doctors’ grading result before and after operation was calculated respectively. The closer the value was to 1, the better the consistency of the three doctors, and the better the stability of the grading scale. The degree of upper eyelid skin laxity before and after operation was expressed as M ( Q1, Q3), and the paired Wilcoxon signed rank test was used for comparison. Results:A total of 50 female patients aged 32 to 67 years old (mean 45.3 years) who underwent bilateral upper eyelid skin laxity plastic surgery were enrolled. The Kendall coefficients of the grading result of the upper eyelid skin laxity of 50 patients by three doctors before and after operation were 0.975 and 0.882, respectively ( P<0.01). It suggested high consistency among evaluators for the same patient. 50 patients were graded as 2(1, 2) degree and 0(0, 0) degree preoperatively and postoperatively, respectively, indicating that the degree of upper eyelid skin laxity was significantly improved postoperatively. The result of Wilcoxon signed rank test showed that there were significant differences in preoperative and postoperative grading result of the three doctors ( P<0.01). Conclusion:The grading scale of upper eyelid skin laxity is objective and easy to use. Its evaluation result are stable and repeatable, and it can effectively analyze the changes of the degree of upper eyelid skin relaxation before and after surgery.

Objective:To investigate the feasibility of a new clinical grading scale for assessing the degree of laxity of upper eyelid skin.Methods:From May 2022 to October 2023, the patients who underwent upper eyelid skin laxity plastic surgery in the Department of Plastic Surgery and Burns-Department of Medical Cosmetology, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, were prospectively enrolled. The degree of upper eyelid skin laxity was graded independently by three plastic surgeons who did not participate in the operation according to the grading scale and using facial photographs of the patients.The clinical grading scale categorizes the degree of skin laxity into 4 grades ranging from 0 to 3 degrees, by analyzing the position of the lower edge of the upper eyelid skin relative to the upper eyelid edge and the pupil, and the higher the grade, the more serious the degree of skin relaxation. If bilateral upper eyelid skin laxity were presented, the grade of the side with more severe laxity was taken as the grade of the upper eyelid skin laxity of the patient. The Kendall coefficient (range -1-1) of the three doctors’ grading result before and after operation was calculated respectively. The closer the value was to 1, the better the consistency of the three doctors, and the better the stability of the grading scale. The degree of upper eyelid skin laxity before and after operation was expressed as M ( Q1, Q3), and the paired Wilcoxon signed rank test was used for comparison. Results:A total of 50 female patients aged 32 to 67 years old (mean 45.3 years) who underwent bilateral upper eyelid skin laxity plastic surgery were enrolled. The Kendall coefficients of the grading result of the upper eyelid skin laxity of 50 patients by three doctors before and after operation were 0.975 and 0.882, respectively ( P<0.01). It suggested high consistency among evaluators for the same patient. 50 patients were graded as 2(1, 2) degree and 0(0, 0) degree preoperatively and postoperatively, respectively, indicating that the degree of upper eyelid skin laxity was significantly improved postoperatively. The result of Wilcoxon signed rank test showed that there were significant differences in preoperative and postoperative grading result of the three doctors ( P<0.01). Conclusion:The grading scale of upper eyelid skin laxity is objective and easy to use. Its evaluation result are stable and repeatable, and it can effectively analyze the changes of the degree of upper eyelid skin relaxation before and after surgery.

Upper lid blepharoplasty is the most common cosmetic surgery for Asians. Excellent blepharoplasty requires surgeons to be familiar with upper eyelid anatomy and skilled in techniques. The formation mechanism of double eyelid folds has undergone many changes. With the deepening of research on biomimetic double eyelid surgery, various innovative and improved blepharoplasty techniques have emerged one after another. This article retrospectively analyzes various double eyelid incision techniques used by domestic scholars to study the theoretical basis and surgical methods of biomimetic double eyelid formation. It also provides a summary of upper eyelid anatomy, double eyelid aesthetic evaluation, double eyelid formation theory, and surgical methods.

Objective:To investigate the cosmetic effect of biplane fixed technique for double-eyelid plasty.Methods:From September 2019 to June 2021, 80 patients, including 6 males and 74 females, aged 18-45 years with an average age of 31 years, were treated with single eyelid cosmetic surgery at the Medical Aesthetics Department of Northern Jiangsu People′s Hospital Affiliated to Yangzhou University. All the cases were performed by the " biplane fixed technique", and the key point of the surgery was to fix the orbicularis labii muscle in biplane (hard fixation plus soft suspension). A questionnaire survey was conducted and preoperative and postoperative photos were collected for statistical analysis to evaluate postoperative outcomes. The patients were follow up for 6-12 months after surgery, and the incidence of postoperative complications were calculated.Results:The incisions of 80 patients all healed by first intention. 79 patients were satisfied, accounting for 98.75%. Physicians evaluated 78 cases as satisfactory, accounting for 97.50%. The Vancouver Scar Scale score was 2.31±1.80, and the Edema and Eczema Visual Simulation Scale score was 3.58±2.15. After surgery, there were no significant abnormalities when eyes opening or closing, and the shape of the double eyelid remained intact without shedding. The scar on the closed eye incision was mild and there was no obvious depression.Conclusions:The " biplane fixed technique" blepharoplasty can form a firm double eyelid line, which is not easy to fall off and has slight scars. The postoperative effect is stable and worthy of clinical application.

Objective:To observe the efficacy of cosmetic suturing techniques combined with topical recombinant human basic fibroblast growth factor (rh-bFGF) in repairing facial trauma.Methods:A prospective study was conducted on 140 patients with facial trauma admitted to the Department of Burn and Plastic Surgery, Northern Jiangsu People＇s Hospital from January to December 2022. Patients were divided into two groups based on different treatment methods using a random number table method: treatment group (70 cases), including 38 males and 32 females aged 3 to 54 (23.1±8.2) years, received cosmetic suturing techniques combined with topical rh-bFGF for wound repair; control group (70 cases), including 36 males and 34 females aged 2 to 49 (22.3±7.5) years, only received cosmetic suturing techniques for wound repair. Patients were followed up 2 weeks post-surgery to evaluate wound healing quality. Patient satisfaction was assessed using the visual analogue scale (VAS). Six months post-surgery, scar conditions were evaluated using the Vancouver scar scale (VSS).Results:In the treatment group, 65 cases were directly sutured, and 5 cases were repaired with skin flaps, with a first-class healing rate of 100% (70/70). In the control group, 66 cases were directly sutured, and 4 cases were repaired with skin flaps, with a first-class healing rate of 91.4% (64/70). The first-class healing rate in the treatment group was higher than that in the control group, with a statistically significant difference ( P=0.037). Two weeks post-surgery, the VAS score for surgical satisfaction in the treatment group was (1.13±0.52) scores, which was lower than that in the control group (2.56±1.32) scores, with a statistically significant difference ( P<0.001). Six months post-surgery, the VSS score for the treatment group was (2.49±1.27) scores, which was lower than that in the control group (4.67±1.93) scores, with a statistically significant difference ( P<0.001). Conclusions:In repairing facial trauma, the combination of cosmetic suturing techniques and topical rh-bFGF can improve wound healing quality, reduce wound scarring, and enhance patient satisfaction with surgery.

Upper lid blepharoplasty is the most common cosmetic surgery for Asians. Excellent blepharoplasty requires surgeons to be familiar with upper eyelid anatomy and skilled in techniques. The formation mechanism of double eyelid folds has undergone many changes. With the deepening of research on biomimetic double eyelid surgery, various innovative and improved blepharoplasty techniques have emerged one after another. This article retrospectively analyzes various double eyelid incision techniques used by domestic scholars to study the theoretical basis and surgical methods of biomimetic double eyelid formation. It also provides a summary of upper eyelid anatomy, double eyelid aesthetic evaluation, double eyelid formation theory, and surgical methods.

On January 1st, 2019, one male patient, aged 55 years, with chronic ulcer in right lower extremity was admitted to Northern Jiangsu People′s Hospital. After admission, ulcer debridement and vacuum sealing drainage (VSD) surgery was performed in lower right extremity. Two pieces of bone-like tissue was removed from the lateral space between the Achilles tendon and fibula in the right leg, which was confirmed as ossification tissue by histopathological sections after surgery. The wounds were treated with VSD technique and dressing changes. On the 49th day after surgery, split-thickness skin graft was taken from the lateral left thigh and grafted to the wound area, which was then treated with VSD. The skin graft of patient survived well. The wound healed completely and the patient was discharged from hospital on day 77 post hospitalization. This case suggests that the patients with chronic ulcer should complete all related examinations in time, and improving the blood circulation of the wound and clearing the ectopic ossification in the wound are critical for wound healing.

Objective:To systematically evaluate the safety and efficacy of dexmedetomidine combined with ketamine during dressing changes in burn patients using meta-analysis.Methods:Foreign language databases including PubMed, Cochrane Central, Embase, and Web of Science were searched with the terms of " burns, dexmedetomidine, ketamine, and dressing" , and Chinese databases including Chinese Journal Full-Text Database, Wanfang Data, and China Academic Journal Network Publishing Database were searched with the terms in Chinese version of "右美托咪定,氯胺酮,烧伤,烫伤,热力伤,换药" to retrieve the publicly published randomized controlled trials on the application of dexmedetomidine combined with ketamine for sedation and analgesia during dressing changes in burn patients from the establishment of each database to March 2019. The outcome indexes included systolic blood pressure at 5 minutes after administration, arousal restlessness score, ketamine dosage, dressing change time, body movement/recovery time, pain score, Ramsay sedation scores at 10 minutes after the start of dressing change and 1 hour after dressing change, physician satisfaction score, neuropsychological symptoms, nausea and vomiting times, nausea and vomiting score. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies.Results:A total of 396 burn patients were included in 7 articles, including 198 patients in dexmedetomidine+ ketamine group who received dexmedetomidine and ketamine for sedation and analgesia, and 198 patients in ketamine alone group who received ketamine alone for sedation and analgesia. The bias risks of the seven studies included were uncertain. Compared with those of ketamine alone group, the systolic blood pressure at 5 minutes after administration, arousal restlessness score, nausea and vomiting score of patients in dexmedetomidine+ ketamine group were significantly decreased, with standardized mean differences of -13.89, -0.84, and -0.99 (95% confidence interval=-20.89--6.89, -1.17--0.52, -1.31--0.68, P<0.01), the Ramsay sedation score at 10 minutes after the start of dressing change and that at 1 hour after dressing change were significantly increased, with standardized mean differences of 1.53 and 0.72 (95% confidence interval=1.05-2.02, 0.13-1.31, P<0.05 or P<0.01), and the number of neuropsychological symptom and number of nausea and vomiting were significantly reduced, with relative risks of 0.20 and 0.16 (95% confidence interval=0.07-0.58, 0.05-0.58, P<0.01). The patients in the two groups were similar in ketamine dosage, dressing change time, body movement/recovery time, pain score, and physician satisfaction score. There was no publication bias in dressing change time or ketamine dosage ( P>0.05), while the other indexes might have publication bias ( P<0.05). Conclusions:Compared with ketamine alone, combination of dexmedetomidine and ketamine during dressing changes in burn patients can reduce the occurrence of restlessness, nausea and vomiting, neuropsychological symptoms, and other complications, better stabilize blood pressure, and enhance sedation effect.

Objective:To investigate the clinical effect of the subbrow blepharoplasty by fixing and folding inward the orbicularis oculi muscle in a single point to improve the upper eyelid skin laxity.Methods:From May 2016 to February 2019, 109 patients (16 males and 93 females)underwent subbrow blepharoplasty combined with single point orbicularis oculi muscle fixing and folding (SBB-soff)in the Outpatient Department of Plastic Surgery Northern Jiangsu People’s Hospital. During the operation, the spindle skin below the eyebrow was excised, and the orbicularis oculi muscle (OOM) was retained. Then we made a small incision at the supraorbital rim, deep down to the periosteum. The OOM was folded inward and fixed on the periosteum in a single point through this small incision. The effect of the operation was evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs.The height margins of the upper eyelids and eyebrow position were evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs (use the iris diameter as one unit). Repeated measures t test was used for analyzing normal distribution data, the non-parametric Wilcoxon test was used for statistical analysis of abnormal distribution data, and P<0.05 was considered to be statistically significant. Results:The incisions of all the 109 cases had primary healing. The postoperative follow-up period averaged a period of (9.57±6.13)months (3 months to 3 years). 85.3% of patients (93 of 109) were followed up for more than 6 months. The subjective questionnaire survey showed that patients’ satisfaction rate was 99.1% (108 of 109) at one month postoperatively, and there were no serious postoperative complications in the sensory function of the forehead, the motor function of eyebrows and upper eyelids, etc.The upper eyelid margins at the sites above the mid pupil points elevated from (0.466±0.149) units to(0.600±0.126) units ( t=-16.186, P<0.001). The upper eyelid margins at the sites above the lateral limbus elevated from(0.387±0.156)units to (0.568±0.166) units ( t=-31.882, P<0.001). The upper eyelid margins at the sites above the lateral canthus elevated from (0.214±0.087) units to (0.446±0.098) units ( t=-49.332, P<0.001). In addition, all the differences were statistically significant.A total of 86 patients were followed up for 6 months without intraoperative eyebrow position adjustment. The data from each measuring point of the statistical baseline to the inferior edge of the eyebrow showed that the eyebrow height at 6 months postoperatively descended slightly, but the difference was not statistically significant ( P>0.05). The periodic appearance and function were significantly improved after the operation. Conclusions:SBB-soff can improve the dermatochalasis and aging signs of the upper eyelid tissue and make no negative effects on the position of eyebrows. In addition, it has the advantages of uncomplicated operation, less trauma, and persistent effect.

Objective:To investigate the clinical effect of the subbrow blepharoplasty by fixing and folding inward the orbicularis oculi muscle in a single point to improve the upper eyelid skin laxity.Methods:From May 2016 to February 2019, 109 patients (16 males and 93 females)underwent subbrow blepharoplasty combined with single point orbicularis oculi muscle fixing and folding (SBB-soff)in the Outpatient Department of Plastic Surgery Northern Jiangsu People’s Hospital. During the operation, the spindle skin below the eyebrow was excised, and the orbicularis oculi muscle (OOM) was retained. Then we made a small incision at the supraorbital rim, deep down to the periosteum. The OOM was folded inward and fixed on the periosteum in a single point through this small incision. The effect of the operation was evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs.The height margins of the upper eyelids and eyebrow position were evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs (use the iris diameter as one unit). Repeated measures t test was used for analyzing normal distribution data, the non-parametric Wilcoxon test was used for statistical analysis of abnormal distribution data, and P<0.05 was considered to be statistically significant. Results:The incisions of all the 109 cases had primary healing. The postoperative follow-up period averaged a period of (9.57±6.13)months (3 months to 3 years). 85.3% of patients (93 of 109) were followed up for more than 6 months. The subjective questionnaire survey showed that patients’ satisfaction rate was 99.1% (108 of 109) at one month postoperatively, and there were no serious postoperative complications in the sensory function of the forehead, the motor function of eyebrows and upper eyelids, etc.The upper eyelid margins at the sites above the mid pupil points elevated from (0.466±0.149) units to(0.600±0.126) units ( t=-16.186, P<0.001). The upper eyelid margins at the sites above the lateral limbus elevated from(0.387±0.156)units to (0.568±0.166) units ( t=-31.882, P<0.001). The upper eyelid margins at the sites above the lateral canthus elevated from (0.214±0.087) units to (0.446±0.098) units ( t=-49.332, P<0.001). In addition, all the differences were statistically significant.A total of 86 patients were followed up for 6 months without intraoperative eyebrow position adjustment. The data from each measuring point of the statistical baseline to the inferior edge of the eyebrow showed that the eyebrow height at 6 months postoperatively descended slightly, but the difference was not statistically significant ( P>0.05). The periodic appearance and function were significantly improved after the operation. Conclusions:SBB-soff can improve the dermatochalasis and aging signs of the upper eyelid tissue and make no negative effects on the position of eyebrows. In addition, it has the advantages of uncomplicated operation, less trauma, and persistent effect.